Provider Demographics
NPI:1265531396
Name:KREIDIIE, MAHMOUD A (MD)
Entity type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:A
Last Name:KREIDIIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26932 OSO PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5815
Mailing Address - Country:US
Mailing Address - Phone:949-948-8880
Mailing Address - Fax:949-348-8881
Practice Address - Street 1:26932 OSO PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-948-8880
Practice Address - Fax:949-348-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29528103G00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist